If You Could Halve the Mortality Rate, Would You Do It?

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Abstract
From approximately November through March of each year, a highly transmissible biological agent infects millions of Americans, leading to an estimated 65 million persons who develop symptomatic illness, 30 million who seek medical care, 300,000 who are hospitalized, and 25,000 who die—the vast majority of whom are elderly [1–3]. This scenario is repeated year after year, despite the availability of a safe, effective vaccine and safe, effective antiviral drugs that are capable of both preventing and treating infection. The annual cost associated with these yearly epidemics in the United States is >$12 billion. Readers may at first be surprised to learn that this biological agent is the influenza virus. More surprising is the evidence that health care workers often fail to protect patients with the available vaccine and antiviral agents. It has taken almost 2 decades to move from a 20% influenza-vaccination coverage rate for persons aged ⩾65 years to a 60% coverage rate, despite Medicare coverage of influenza vaccination during this period. This slow rate of coverage has occurred even though national recommendations have been in place for the universal use of influenza vaccine in the elderly population since the 1960s. An even higher goal has been set by the US Public Health Service: to increase influenza and pneumococcal vaccination rates among individuals aged ⩾65 years to a 90% level